Greetings from Secondments

After spending a month in Padua, I was more than impressed by the culture and what it has to offer. The secondment itself was a short period (one month) but nevertheless I experienced a lot with the great help of Professor Piera Poletti. Thank you so much. I also want to thank warmly Professor Katri Vehviläinen-Julkunen, Senior researcher Tarja Kvist and Chief executive nursing officer Merja Miettinen for enabling me this great opportunity.

During the time I spent in Padua, taking part in the INEXCA project gave me an important opportunity to spend some time deepening my knowledge in nursing science. In addition, it was inspiring to meet different people working with health care quality, there were many things to learn and I learned a lot from Italian system. For example, as the main focus of psychiatric care is outpatient care, so there are practically no psychiatric hospitals in Italy.

Professor Piera Poletti had arranged my exchange program. Piera introduced me to two hospitals: ULSS 7 Pedemontana and Ospedale alto Vicento. I was surprised (do not know why) by the Italian hospital architecture and construction solutions. For example, the units did not have separate offices for nurses, instead nurses worked in open offices. The structure of the institutions was such, that nurses were always close to the patients. Starting from patient arrival to the unit in the hospital lobby, patients were received by professionals and experienced experts. They had a unified space, like in the hotel lobby. What is now planned in Finland has been done for many years in Italy!

It was also very interesting and well worth visiting the University hospital. What I noticed was that many problems are the same we encounter in Finland. Padova´s Hospital was the largest hospital I have ever been to. There were altogether 1400 beds. I also met several nursing staff members and managers. Attention to all hospitals: there were hospital top managers' photos displayed on the front walls of the hospital as well as on the unit walls. So, the patients saw who was responsible for everything. I did also draw attention to the number of trained nurses, which was very few. For example, in the children's emergency department, the number of patients was about 80 per day, and there were only two nurses working per shift. The cardiological unit had 24 patients and four trained nurses. In Padua there were volunteers working in each unit, doing agreed helping and supporting activities for the patients and their families. Patients' families are also an important asset and they are expected to arrive early in the morning to the departments.

Hospital outside and inside.

Open office of the nurses and new part of Padova University Hospital.

I was with Professor Poletti in hospitals while she trained the staff. The training was multidisciplinary involving doctors and nurses. Lecturing days were long, starting at 8.30 and continuing until 13.00. Then there was an hour meal time, which was the time for the employees. They stamped themselves out. The lecture continued at 14 a’clock and ended at 17 or 18. The students were well focused even though there were no breaks. Despite the length of the education, the participants were very active during the education period, discussions were vivid. No one used their cell phones or computers during the education. Professor Poletti often reminded of the importance of keeping the balance between work and leisure. So, let's watch the hills and mountains in the sky and explore the Italian culture and history and enjoy good Italian coffee. As I worked at CEREF's office and lived in near distance, so I had a short walk to the office, so I enjoyed especially the Padua's morning! I had some interesting discussions about nursing management with Senior lecturer, University of Eastern Finland Pirjo Partanen. We also discussed research working and collaboration when we are back home. It's was very important to share experiences with Pirjo!

A lot of respect and admiration awakens the history of the University of Padua, founded in 1222. The famous Galileo Galilei was there a lecturer at the University of Padua. As Galileo Galilei was in height rather a short man, so the students wanted to give him a higher place to give lectures, and thus funded his or her own the speaker's platform.

While you visit Padua, you must try Caffe Pedrocch's green coffee, which is both warm and cold, and great tasting! Grazie!

Caffe Pedrocch's green coffee.

University of Eastern Finland → University of Pittsburgh Professor Katri Vehviläinen-Julkunen, October 2018

It was wonderful to yet again visit the University of Pittsburgh, one of the top leading universities with highly ranked research and education. Pittsburgh is beautiful this time of the year with all the colorful leaves and decorations for Halloween, of course.

This time my short visit to Pitt showed the darker side of the human nature in a dreadful way. I was here when the shooting in the Tree of Life Synagogue happened killing 11 people and injuring six people on 27th October. According to Pittsburgh Mayor Bill Peduto this was “The Darkest day of Pittsburgh’s history”. President Trump with his wife visited the city to meet the grieving families and citizens. The shooting took place quite near to where I stayed this time and where I walk to the university. People in the city showed strong feeling of togetherness during these days.

I had wonderful time with professor Paula Sherwood and professor Heidi Donovan to advance our collaboration. Also, we advanced the outcomes of the project INEXCA by drafting manuscripts. I had the pleasure to meet the Dean of the School and Director of the International Services at Pitt, too. From Kuopio Dr. Tarja Välimäki is now working with Heidi Donovan with our caregiver data collected for INEXCA. She is also getting training in research methods and interventions. We had fruitful meetings with Tarja to discuss our findings.

Tarja had her birthday during my time in Pitt and we celebrated the occasion during a working lunch in an Italian restaurant!

Three months in Denmark was memorable and we learned a lot in various aspects. I would like to thank Associate Professor Christian Von Plessen and the people in Centre of Quality for their help during our secondment. Especially, Monika helped us not only in work but also outside of work to make our secondment go smoothly.

We kept developing the support platform for the INEXCA project. We had a nice meeting about remote health care with Ulrik Gerdes. He gave us insight on how things are done in Denmark and in the United States for remote health care.

Also, it was inspiring to work with people in a different area, quality in healthcare. There were many things to learn. For example, we learned about healthcare related products in software development.

We attended Bettina Ravnborg Thude’s defence about Leadership in Danish Hospitals. This was the first defence in which Kayo has attended. Again congratulations to Bettina for getting her doctorate.

Bettina Ravnborg's defence

Center of Quality if located in Middelfart. Middlefart is a small town but it takes only a several minute walk to a beautiful sea view with two bridges and to the CLAY Museum of Ceramic Art Denmark. The museum has a great collection of the ceramic art.

CLAY Museum of Ceramic Art Denmark

What we really liked about this town is that there are lovely houses on many streets. They are like houses in fairy tales. We loved just walking down the street and enjoying the atmosphere.

Thank you again for everyone in Center for Kvalitet for their hospitality and hope we meet again.

Six weeks at the School of Nursing, University of Pittsburgh have been rewarding, productive and refreshing time. Working with the colleagues in highly appreciated and ranked school (QS World University Rankings Nursing: No. 16th in the world) has been a privilege for me.

INEXCA project is running the last year and we are working with many important topics. The research part is progressing forward in different countries and secondments (exchange and training periods) are going on. We are finalizing our symposium; Personalized cancer care - Combination of research and practice. The symposium will be on 13 - 14 June 2018 in Kuopio. We hope to see many of you in our symposium! You are warmly welcome!

Professor Paula Sherwood from the University of Pittsburgh and I have been preparing the program of DIS (Dissemination Implementation Science) workshop, Pittsburgh, USA, 10 - 11 September 2018. INEXCA project offers excellent learning experiences of international teamwork. In this visit, I was participating in one research methods course for PhD students. Especially I liked two very high quality lectures. One was about health services research and evaluation held by professor Grant R. Martsolf. He is a new professor at the School of Nursing and his health services research is known widely. Professor Douglas Landsittel from the Department of Biomedical Informatics gave a lecture about comparative effectiveness research (CER). His presentation gave new views and it also supported the INEXCA CER course, which was held by professor Walter Sermeus in the INEXCA project last September in Leuven. PhD students presented some parts of their proposal. Their goals are high and they are very motivated to implement their research projects.

It always very fruitful to be involved in different classes at different phases of studies. Professor Judy Zedreck-Gonzales had a very important topic, health economics, for the bachelor level students. I was told that the students have few classes where they learn about health economics even though those skills are really needed. Professor Judy Zedreck-Gonzales was seconded by the INEXCA project last autumn when she visited our department and the Kuopio University Hospital. Now we are planning a new visit for her. Judy is a great expert of leadership topics and Magnet Hospital.

I met the Dean of the School of Nursing, Professor Jacqueline Dunbar-Jacobs and Chair of Acute and Tertiary Care Department, Professor Annette DeVito Dabbs. Discussions with them and with Director for International Affairs at the School of Nursing, Brian Greene, were looking for the continuum of our collaboration in future. Collaboration with the School of Nursing, University of Pittsburgh and our department has been good.

My last day was a Spring Graduation and Pinning Day Ceremony. I was following this nice ceremony for the first time. Most of the graduates were Bachelor of Science in Nursing but there also were some Master of Science in Nursing Science. In total, there were more than 200 graduates. They all got the pin and the lamp of Florence Nightingale. Doctor of Nursing Practice (DNP) were quite a good number. There were three Doctor of Philosophy (PhD). Keynote speaker was Susan B. Hassmiller, PhD, Senior Advisor For Nursing, Robert Wood Johnston Foundation. She underlined the compassion in nursing. Nurses can be technically highly professional, but compassion is sometimes missing. I thought that these were wise words. We all need to remember compassion in our work.

Pittsburgh is a real sport city. The NHL playoffs were taking place and I share the opinion that the Pittsburgh Penguins is the best team. I saw their last regular season game against Ottawa Senators. It was fun. I also went to my first baseball game, which was also interesting, but too slow for me. Anyhow, ti was a once-in-a-lifetime event. In addition, Pittsburgh has many cultural attractions, like high quality symphony orchestra, which concerts I also enjoyed. The Phipps garden had beautiful spring exhibition and I visited in a local nursery with professor Paula Sherwood and her mother Jan Riess. My own gardens are waiting for my hands, so it is time to come back home with nice learning and life experiences. Thank you nice colleagues and friends in Pittsburgh!

NHL playoffs, Pittsburgh Penguins - Ottawa Senators

American baseball game

Paula Sherwood, Jan Riess and Tarja Kvist at a local nursery

SenSoftia Oy → University of Leuven Tech Lead Iiro Tenhunen, October 2017

Greetings from Leuven,

Our journey to Leuven started in the beginning of October and lasted for the whole month. I was little bit nervous because it was my first time in an airplane and especially because it was my first time abroad. But I was able to go there with my work mate Kimmo and soon I realized that it was not needed to worry and stress about the trip. When we finally arrived to Leuven it was so exciting because most of the city looked very old which was so different to what I was used to see in my home country Finland. Religion was also a pretty visible part in Belgium. There were many churches in the cities with carillon concerts every Tuesday and Thursday.

In the evenings and weekends we spent our time exploring city and restaurants. We also visited Brussels and Bruges. The cities were a lot like Leuven with many old and historical buildings. There was a lot of tourism in the cities and horse drawn carriage tours seemed to be quite popular.

In Brussels, the highlight was to visit in the Belgian Comic Strip Center to learn about history of certain comics and comic book writers. In Bruges, we visited in belfry and got nice pictures of the city. We also ate mussels in one of the best restaurants out there.

The weather was very good during the whole trip. It was mostly warm and sunny including few rainy days. We met nice people at the university and had a great time with each other. The best travel abroad so far!

After spending a month in Leuven, I was more than impressed about the nation's culture and what it has to offer. The secondment itself was short but in this short period I got to experience a lot with the help of Professor Walter Sermeus and his colleagues. We got important system updates done during our stay in Leuven.

A special thanks to Cristian Girotto for his help whom with we managed to translate the INEXCA Platform into Italian. Also, me and Iiro ended up spending a lot of free time with Cristian after office hours.

One of our weekends we went to Brussels for a quick sightseeing tour with Iiro. We didn’t have anything planned so we just walked to places where the road lead us. This ended up being successful after seeing a lot of the tourist attractions on the way.

Entrance statue of Belgian Comic Strip Center

On one weekend the three of us hopped on Cristian car and headed to Bruges for a day trip. In Bruges we managed to eat some of the famous Belgian mussels and of course the taste was wonderful.

Thank you again for everything and maybe I will meet again with our Belgian colleagues on our last remaining secondments this summer.

During the three months spent in Leuven, the participation in the INEXCA project gave me the opportunity to spend some time in deepening my knowledge on nursing research and on cancer patients’ perception of care. Moreover, the cooperation with the two Finnish computer scientists from SenSoftia who were in Leuven while I was there and the Belgian student who carried out the local survey was very useful. I want to thank professor Piera Poletti for giving me the opportunity to participate in this project and her and professor Walter Sermeus for directing and supervising me during the whole period I was here.

With the help of professor Sermeus, I have deepened my knowledge on the tools that compose the patient questionnaire, I have done analysis of data and discussed with him the results and their meaning. At the same time, with professor Poletti, I have carried out a literature review on cancer patients’ experience and their perception of healthcare services.

Collaborating with people from other European countries has offered an excellent opportunity to exchange and learn from our traditions and cultures.

The time spent here also gave me the opportunity to learn the Belgium from a historical, environmental and cultural traditions. I visited many cities (my favorite is Gent!), numerous parks, gardens and natural reserve (Rochefort cave was very interesting and spectacular), and various museums, old abbeys and castles (my favorite is the old abbey of Villers-la-Ville). Furthermore, in December in every city there are beautiful Christmas markets with many local culinary specialties and the ever-present Ferris wheel!

At the arrival to Kuopio in September we were greeted by beautiful weather and sunshine. We were welcomed by the Director of Nursing at the Kuopio University Hospital, Minna Taam-Ukkonen. I quickly learned looking at the beautiful countryside about the more than 187,888 lakes. Absolutely beautiful.

The first Monday morning began an exciting week at the Medical Center. Tours of areas such as Oncology Services, Neonatology, Cardiology and Neurosciences were just some of the departments that shared robust and visionary interest and excitement in the growth and development of their programs. It was lovely to see the pride of every individual.

During the week there was specific time to meet nursing and research leaders who has interest in the Magnet designation and the critical steps in this journey. My experience in Magnet organizations and training as a Magnet consultant allowed me to share experiences over the past 15 years as well as answer specific questions. Topics included the Magnet process, conducting the gap analysis, the importance of transformational leadership at all levels of the organization, selection of qualified leadership and evidence based management. The seminars were engaging and interactive and very well attended by the busy medical center leadership. There were many people who facilitated my visit – especially Minna Taam-Ukkonen and Mari Kiema. The last day in the medical center was with the medical chairman and my husband, Dr Alejandro Gonzalez attended to share his experiences as president of the medical staff when his hospital achieved Magnet recognition.

Tarja Kvist, Judy Zedreck Gonzales and Anu Nurmeksela at a Nursing Leadership course at the University of Eastern Finland.

The second week was with Tarja Kvist, Associate Professor at the University of Eastern Finland. I was given the opportunity to meet personally with the Nursing Program Director, Professor Hannele Turunen, Department Head, and then lecture to nursing leadership students. Topics included Magnet and transformational leadership as we realize the importance on including our nursing future in the journey for Magnet. Evidence Based Management and Practice were also key topics of presentation. Discussion during the week illustrate the opportunities for future collaboration on defining needs in leadership development and factors in nurse retention and avoidance of compassion fatigue. I was able to reconnect with Jaana Seitovirta, a UEF PhD candidate who I had the pleasure of meeting in Pittsburgh last year.

The secondment was infused with an introduction to the rich culture and warmth of the Kuopio community. My husband and I walked each day to the city center and enjoyed the cuisine and hospitality of the area. The last weekend of September, we took the convenient train service into Helsinki and enjoyed your beautiful capital city! AND we were sure to experience the saunas in Kuopio before we left to return to Pittsburgh!

Plans are in place to continue dialogue and joint research opportunities!

I have been honored to take part in the INEXCA (Excellent research and expertise of quality of cancer care by internationally trained staff) project research secondment in Padova, Italy. I would thank warmly Professor Katri Vehviläinen-Julkunen, professor Piera Poletti, senior researcher Tarja Kvist and Chief Executive Nursing Officer Merja Miettinen for this great opportunity.

Professor Piera Poletti has organized my exchange and shift here in a effective and innovative way. In the wholeness every element has been in the right balance. I have got inspirational and memorable learning experiences about Italian culture and history, enough working time with my project in the beautiful and pleasant CEREF`s office and discussions about health care quality, risk management, the content and methods of further education and life in general with professor Poletti. I have received a huge amount of evidence-based knowledge and information about the best practices, about health care quality and indicators, patient safety and risk management.

Padua (Padova) is located in the northern part in Italy and the city´s population is 214000. The city's streets open into large and beautiful piazzas and there are many bridges, ancient walls and gates surrounding the city. Much respect and admiration arouse from the significant history of Padova´s university. The university was founded in 1222 and Galileo Galilei was a lecturer in Padova´s university. One of my favorite places is Prato della Valle, one of the best known places in Padova. I enjoy tremendously my every morning walking through the Prato della Valle, the 90000 m2 elliptical square. In the centre is a wide garden surrounded by 78 statues. I visited also Scrovegni Chapel which is Padova´s most popular attraction. Its frescoes were completed by Giotto in 1305. During the visit I was able to learn more of the Biblical stories from the frescoes.

A frescoe by Giotto.

What I have learned? I was able to attend Professor Piera Poletti's multi-professional management all day education. In Italy, the rule is that some of the health care education needs to be multi-professional: for instance in terms of health care quality and patient safety. This has also resulted in the involvement and motivation of medical staff in the development projects. The subject of education waspatient empowerment (patient-centered care). The education was held in Italian but it didn´t bother me because the key concepts are same in Italian and English. The education covered a wide range of patient self-care and patient-centered care with the most versatile learning and teaching methods. Professor Poletti used clearly experiential learning theory, concepts and methods. The experimental learning theory is a holistic perspective that combines learner´s experience, perception, cognition and behavior. The participants worked together on the subject, for example, the standard for patient participation implementation in their own hospital. Despite the length of the education, the participants were very active during the education period. No one used their cell phones or computers during the education.

This week I got involved in Professor Poletti's all daypatient communication education (health care quality, patient safety and risk management), which was held to physicians. I again learned a lot about this topic and pedagogical methods. And what was great in my opinion was that the physicians whom attended this education were very motivated and involved. They told many ethical insights about communication with patients. I admired their focus on the whole day education. Poletti used the drama pedagogy and it contained three different patient communication exercises that were linked together.

The participants of education.

This week I also went to the Padova´s Azienda ospedaliera Universitaria (a joint hospital by the Region and the University), where I met shortly the head director of nursing, Achille Di Falco. I will meet him again next week when I´ll go to the hospital for a new visit. Hospital´s nursing student numbers are quite different from Kuopio University Hospital (KUH). They have only 300 nursing students in the Padova azienda ospedaliera-universitaria each year in the hospital clinical practice, when in comparison KUH has about 1000 nursing students per year. Clinical placement of students will be carefully considered in relation to Padova university hospital´s future recruitment needs. In addition, students are ready to take advantage of good clinical skills and are prepared for patient care when they´ll graduate. They have been wondering KUH´s long education programs for the new nurses. Short discussion gave to me a lot of new ideas and topics in the student´s clinical placements.

And the latest I learnt was how to usethe keys and the locks in my home and CEREF´s office (in total 6 locks). In the beginning I was in big problems with them, but finally I have learnt how to open and close the locks. But it demanded a lot of patience and humor from professor Poletti and my house owner!

Just after arriving from a secondment to Pittsburgh in February - March, I rushed for a secondment to Padova in March - April. I was invited to Cynthia Vescio’s wedding on 25th March in Padova. Cynthia was visiting in our department in summer 2016. So we became friends and I was so happy to be a guest with our collaborator, professor Piera Poletti at Cynthia’s and Giorgo’s elegant wedding. What a wonderful day: beautiful couple, sunshine, lot of delicious food and nice company.

I worked every day at Piera’s nice office. We had many fruitful discussions about our health care systems, education and of course, life. I was happy to go with her to some health care organizations, follow her teaching, and discuss with the professionals. I also visited at the university and lectured about international research collaboration. Everywhere I had possibilities to meet and change ideas with Italian students and tell about Finnish health care system and education. Hope to see some of them soon in Finland!

Now, in October, after such a poor summer in Finland, I have to say I am so grateful about my four weeks in Padova. I experienced one summer there. Weather was great, sunshine, flowers, sitting in piazzas. I also saw the catholic Easter, which was beautiful and being in church was very empowering. At the weekends, I saw the famous Museum of History of Medicine in Padova, Botanical Garden, Scrovegni Chapel, Basilica di Sant’Antonio and many excellent restaurants and cafeterias. Especially, the famous cafeteria Caffe Pedrocchi with mint coffee was worth of visiting. Day trips to historically and culturally rich cities Venice and Verona told more about Italy.

In spring and early summer of 2017, I got the opportunity to take part in the INEXCA project within the course of Nursing Science Expertise in health promotion: practical training in the Department of Nursing Science at the University of Eastern Finland (UEF). My task was to interview patients being treated for breast cancer, lung cancer or prostate cancer at the Sädesairaala radiotherapy clinic at the Kuopio University Hospital in Finland.

I got acquainted to the INEXCA project and its aims through my teachers, the INEXCA Coordinator, Professor Katri Vehviläinen-Julkunen and Senior Researcher, Docent Tarja Kvist at the Department of Nursing Science and by studying the home page of the project.

The University Hospital Research Assistant, Radiation Therapist Aija Juutilainen invited the patients and arranged a timetable for the interviews. Usually they took place on the same day as the patient’s radiation treatment or doctor’s appointment.

The University Hospital Research Assistant, Radiation Therapist Aija Juutilainen and Margareta Rydén-Kortelainen at the Kuopio University Hospital.

The interviews were mainly held as focus group interviews. In this case a “focus group” means both the group – patients with the same diagnosis – and the theme for the interview, which was the patients’ experiences of the disease, it's treatment and received support during treatment and recovery.

Women were more positive to being interviewed than were the men. Altogether 21 women and three men accepted to be interviewed. We have planned to continue interviewing male patients during the autumn of 2017.

Preparing for the interviews I studied literature concerning research interviews, followed my teachers’ (Katri Vehviläinen-Julkunen and Tarja Kvist) advices and examples and made two pre-interviews. Having been a nurse for 30 years, I have gotten familiar to listening to patients, but conducting a research interview is something different!

The interviews were semi-structured. The questions had been worked out earlier in the project and I received them from my teachers. However, with the approval of my teachers, I did some minor changes (mainly the order of the questions and the word order within the question) with the goal, that the participants would be able to talk freely about their experiences. Working with the questions and taking them “to my heart” was an interesting process, where I found very many aspects of the research work being present at the same time: the research theoretical framework as well as ethic, linguistic, social, psychological, practical and administrative aspects.

Generally, the patients did talk very openly about their experiences. In many cases they shared each other’s experiences and gave support to each other. I tried to create a comfortable atmosphere and tried to give everyone an equal chance to talk.

The interview time available (about one hour) was the “frame” within which you could deepen the interview and listen to the patients. Actually, I had the feeling that the discussion could go on for even longer, but unfortunately it was not possible. Practical things such as treatment appointments or patient transport times were agreed on beforehand and they set the limits of interview.

During interviews, patients told about many things connected with different stages of the treatment process. From many things patients' experiences were very positive, but they also expressed some further needs and suggested some possible improvements. It will be very interesting to see what the results of the interviews will be once they are analysed!

In addition to conducting the interviews I got the opportunity to meet the INEXCA Project Manager Maija Hartikainen at the UEF Project Management Services. Listening to her gave a lot of interesting views on the administration and co-operational work within such a sizeable project as INEXCA. It also gave me a hint on how European Union project funding works and how EU instances work to implement European goals.

In the light and spacious waiting room of the Kuopio University Hospital Sädesairaala radiotherapy clinic you find on the wall the original notes to a newly made symphony: It is the Finnish conductor and composer Professor Leif Segerstam's 275th symphony Trusting Cyberknife's Knowing and Seeing from 2014. It was created after Segerstam had been treated with the Kuopio University Hospital CyberKnife (the only one so far in the Nordic countries) and being cured from prostate cancer. In the symphony Segerstam has written a wide range of feelings, that a patient can go through with the disease and its treatment, and even the sound of the CyberKnife’s robot tentacles moving. With his music, Professor Leif Segerstam wants to give hope and strength to his fellow patients to fight the cancer and experience the wonder of being cured. The process of getting sick, being treated and getting cured can be a life changing experience for the patient. Segerstam expressed this in music. The handwritten score is impressive to see!

The handwritten pages of the symphony decorate one of the walls of the light and spacious waiting room of Kuopio University Hospital Sädesairaala radiotherapy clinic.

Puskala V. 2016. CyberKnife-symfonia avasi Sädesairaalan. Pohjois-Savon sairaanhoitopiirin kuntayhtymän tiedotuslehti Henkreikä 1/2016. (The CyberKnife symphony was played at the radiotherapy clinic inaugural ceremony. The information newspaper Henkreikä for the district of Kuopio University Hospital. In Finnish.)

University of Eastern Finland → University of Pittsburgh Early Stage Researcher Jaana Seitovirta, Spring 2017

Greetings from the University of Pittsburgh, School of Nursing, where I have had an excellent option to work under the INEXCA project (Excellent research and expertise of quality of cancer care by internationally trained staff) between February and April 2017. This was my first trip to the United States of America and my supervisors warmly recommended this wonderful possibility.

This has also been an important international research training for me. I have learned about project working and different roles there and how to plan data collection relating to INEXCA project. In addition, I have learned about research team working in collaboration with Professor Paula Sherwood and other members of Professor Sherwood’s research team. I have participated in different courses in University of Pittsburg, School of Nursing, during my stay; the Manuscript Preparation, Theoretical Foundations for Research, Research Methods and Finance and Economics for Health Care Leaders courses supported my working with INEXCA-project. As a bonus - I have learned about American culture and spoken English every day of course. For example, I have improved my teaching skills by giving two presentation to the local and international PhD students.

The picture below I saw every day when I walked to the UPMC Presbyterian hospital café to have my lunch. It reminds me of how important it is to have the feeling of being a piece of a puzzle.

The University area in Oakland is safe and quite wide and there are few museums and many historical buildings.

By the way - did you know that Andy Warhol was born and raised in Pittsburgh – Andy Warhol Museum is one of the four excellent Carnegie Museums of Pittsburgh.

Finally, I want to thank the INEXCA project (co-funded by the Horizon 2020 program of the European Union) giving me the opportunity to participate in this training period. I have really enjoyed my eight weeks in the University of Pittsburgh. For me personally, regarding my own research project and career, I have had a wonderful time and I am very grateful for this experience in one of the best Universities in the USA.

My second, five-week secondment in Pittsburgh was in February–March 2017. Time went like flying. Finally, we printed the patient and care giver questionnaires and packed them and brought to the hospital. Now we can only wait for lot of interesting answers. Before starting the data collection, I had to study the research ethics according to the University of Pittsburgh and University of Pittsburgh Medical Centre. It was a useful experience to go through all courses and tests. Maybe it would be needed in Finland for every researcher. Again research and training are combining nicely, which is the main goal of the INEXCA project.

Jaana Seitovirta, Research Assistant Sue Misko and Tarja Kvist with piles of questionnaires.

I am proud of the high rankings of Nursing at the University of Eastern Finland and the University of Pittsburgh in the QS World University Rankings by Subject 2017. The University of Eastern Finland was ranked 42nd and University of Pittsburgh 17th. I was so privileged to work at the University of Pittsburgh with excellent researcher colleagues. I learned something new every day.

At the campus, one interesting place to visit is the Cathedral of Learning, a Pittsburgh landmark, listed in the National Register of Historic Places. Standing at 535 feet (163 m), the 42-story Late Gothic Revival Cathedral is the tallest educational building in the Western hemisphere and the second tallest university building (fourth tallest educationally-purposed building) in the world. It is also the second tallest gothic-styled building in the world. The Cathedral of Learning was commissioned in 1921 and ground was broken in 1926. The first class was held in the building in 1931 and its exterior finished in October 1934, prior to its formal dedication in June 1937. From the 36th floor it is possible to see all around the Pittsburgh area. The Nationality Rooms are decorated by the characteristic culture of the every nation. The Finnish room is still under constructions. I visited the Italian room and found a chair of my next secondment, Padua. I will travel to Padua very soon after the secondment in Pittsburgh.

Padova 1222 chair at the Cathedral of Learning

I was lucky to visit the St.Margaret’s hospital again. The hospital was the first hospital of UPMC’s hospitals which got the Magnet Status in 2009. Early stage researcher Jaana Seitovirta and I had an empowering day there with the wonderful nurse leaders and other staff. The president of the hospital, David Patton welcomed us to the visit. Nursing really had a value in this hospital. We had great time with Magnet Program Director, Director of Professional Development Lisa Lehman, Chief Nursing Officer Mary C.Barkhymer, Nurse Leaders Beth Savage and Doris Cavlovich and Administrative Coordinator Assistant Lisa Nicholas. We, Lisa Lehman and I, had met already eight years ago. The hospital is located a little bit out of the city. The hospital has around 250 beds and cancer care is one of their services.

At the St.Margaret’s hospital, the patient satisfaction survey is going on all the time and job satisfaction is measured regularly, too. Leadership is transformational leadership. The nurse leaders go to work with the staff in different units. This practice gives an exceptional opportunity to meet staff, discuss with them and meet also the patients. Nurse leaders are well known and it is easy to approach.

At the end of my secondment I was in Healthy Work Environment Congress organized by Sigma Theta Tau International in Indianapolis. It was nice to meet the researchers interested in same research themes which have been my interest for years, like transformational leadership, recognition and job satisfaction. The participants were mostly from USA and Canada, some from Japan, Nigeria and of course Jaana and I from Finland. The healthy work environment is an important part of cancer care services. As I often to say: Wellbeing nursing staff is the best guarantee for the high quality of care. We were also priviledged to discuss with the President of STTI Cathy Catrambone. The Finnish nurse researchers are highly appreciated in STTI.

Thank you professor Paula Sherwood, professor Margaret Rosenzweig, professor Judy Zedreck-Gonzales, associate professor Rose Hoffman, project manager Jason Weimar and many others, you made my time at the School of Nursing, University of Pittsburgh, great once again. Few days at home and again for the secondment in Padua. New learning experiences were waiting for me.

University of Eastern Finland → University of Pittsburgh Professor Katri Vehviläinen-Julkunen, November 2016

INEXCA is going wild!

International research collaboration is truly important! I had the pleasure to be a visiting scholar in the University of Pittsburgh, one of our partners in H2020 INEXCA project. I am really grateful to professor Sherwood and her team of the possibility to meet again. UEF was really visible at Pitt as so many of us were there at the same time. During my stay we visited Wiser simulation labs and met a lot of professors working around excellent education for medical and nursing students. Highly interesting!

To have a possibility to visit UPMC Shadyside, a Magnet hospital, was a joy and to be able learn of their impressive outcomes! Finland truly needs the type of activity! As for academic activities, we are working with data collection in UPMC Cancer Center, reviews, participating evidence based practice course and updates of statistics for Pitt staff among many other things. Good ideas for us, maybe?

Thanksgiving and Black Friday is an experience to remember – Families really come together! With lean thinking we say “Go to Gemba” but I would say be truly international! Professor Paula Sherwood will visit us again in May 2017!

Thanks to the European Union funded project – INEXCA, I have the pleasure to work in the one of the world’s best Schools of Nursing again. Feeling more familiar with everything after the last time I was here, I’m trying to ensure that I get as much new experience as possible. Luckily, there is plenty to learn during the three months I am here.

First of all, I get to work with excellent world-renowned researchers such as Professor Paula Sherwood. Second, I get to see how large NIH research grants and projects are planned, developed and lead, which gives me a lot of knowledge and ideas for my future scientific career. Third, I get to share my experience and improve my teaching skills by giving guest lectures to the local PhD students; we can learn so much from each other! Finally, I get to experience American academia to the fullest by simply observing the way things work here and asking as many questions as possible to increase my understanding of both the scientific and clinical world.

Having the UEF team with me, docent Tarja Kvist, Professor Katri Vehviläinen-Julkunen, and docent Merja Miettinen (Chief Nursing Officer from Kuopio University Hospital), makes my Pittsburgh experience much more valuable as I get to share and discuss aspects related to my INEXCA work here with my mentors practically right away. In my free time, I’m enjoying the beauty of autumnal Pittsburgh and cheering Pittsburgh Penguins, the local professional hockey team.

It is time to finish my seven weeks’ secondment in Pittsburgh. As I promised you will get my follow-up now. When I started my period here it sounded long, but soon I noticed that the days were running. That happened once again for me.

One of the most important things was to promote the start of coming data collection here. Luckily the coordinator, professor Katri Vehviläinen-Julkunen and I were happy to do it together with professor Paula Sherwood, professor Margeret Quinn Rosenzweig and project manager Jason Weimer. The plans are progressing well. Another nice outcome was the quality appraisal of the articles for one literature review, which Natalia, Katri and I made together. New ideas for further research are maturing.

UPMC campus area waiting for the holiday season

I was happy to be involved in many different classes and really get the inspiring training. I myself told about international research collaboration for the PhD students. Hope to get someone to come in Finland. I followed the evidence-based nursing course for very heterogeneous group of the students, qualitative research methods for the PhD student as the professional development course. Just recently PhD students were presented how the research group works, which are the roles of the principal investigator and project manager. In addition, one very interesting weekly meeting was the research grant writing meeting for the assistant professors. I really enjoyed going to this meeting every Monday. I got to know better the interesting research done at the department. In addition, the lecture of Statistical Methods for Quality Improvement Project by PhD Dianxu Ren was very good training for me and for the whole staff of Nursing School. The opportunities to learn more about the different methods were the best training and they challenge me to teach much better at my own department.

My research roots are deeply in health service research, and I was lucky to see one of my interest areas once again, Magnet hospitals. I went with the CNO Merja Miettinen from Kuopio University Hospital to meet the Administrative director of nursing education, practice and research Peggy Hayden in Passavant Hospital. The hospital has just submitted their documents to be evaluated for the Magnet Hospital Status. This hospital has 400 beds and 800 RNs. They have developed the hospital for seven years according to the Magnet principles and 3,5 years ago they decided to aim to get the status. I like the Magnet ideology a lot; excellent quality of care, evidence-based practice, highly motivated and committed staff and transformational, modern leadership. This was interesting for me, because when I first time came in Pittsburgh, my interest was in Magnet Hospitals. Despite, Passavant hospital had the cancer care clinic, too. The hospital was at a very beautiful valley area, the buildings were nice and the pianist was playing in a lobby.

Passavant Professional Practice Model

I would like not to forget the time outside the university. Thanksgiving, very American celebration was once again a nice experience with all excellent food. I went to see two different Christmas shows. However, the most relaxing day was one Saturday which I spent with Paula in her daily life outside the university. Early in the morning we sat in the basketball game at her son’s school. In the afternoon Paula’s older son offered the best cultural experience of my journey. It was a concert of Honors Band, high school students in Westminster Collage. There was the real joy of playing, when 120 best young students were playing together.

Now it is time to say farewell and thanks to my colleagues in Pittsburgh. You all have given me excellent experiences. I will go home with a lot of inspiration and joy. Happy Holidays!

Tarja Kvist with the Penguins players Evgeni Malkin and Sidney Crosby

1 November 2016

Happy Halloween was just yesterday, next week the presidential elections and Thanksgiving at the end of the month. Great timing to be just now here in Pittsburgh!

I came here on the 20th October for my seven weeks long secondment. This is my fourth time in Pittsburgh during the last seven years. Professor Paula Sherwood and her wonderful research group has made me feel really welcome. They have already offered me good learning experiences how they do research and work in research group. I have been involved in the research group meetings and the course of professional development of the doctoral students. The Annual Poster Exhibition of the School of Nursing was really worth of seeing. Discussions with the colleagues give new views for own work. In addition, I am happy to work here together with PhD student, early stage researcher Natalia Sak-Dankosky, too. At the moment we are doing the quality appraisal of the literature review articles. Every day is full of interesting work and I notice that our INEXCA project is really fruitful.

Professors and PhD students of Professional Development Class

Tarja and Associate Professor Rose Hoffman

Before leaving home I had the dream to see Hillary Clinton. This dream came true on my second day in Pittsburgh. I was lucky to go on her rally with my kind landlady. So I have seen Hillary Clinton, maybe the first female president of USA.

Hillary Clinton and Tim Kaine

Lili has been my wonderful landlady since my first visit here. She has offered me nice company for the different cultural events and delicious dinners. Of course I have showed my cooking and baking skills in her kitchen. Her home has been my American home. Area where I live is Shadyside, under 5 kilometers from the university, a very nice and peaceful part of the city.

The ice-hockey game is waiting for me. The ticket is ready for the Penguins’ game against Minnesota Wilds. Many good Finnish players will be on the ice, especially Penguins’ defenseman Olli Määttä.

First of all, please let me thank Tarja, Katri, Maija and the University of Eastern Finland Department of Nursing‘s people, who welcomed me and provided me with a desk and a computer in the shared researchers’ office. Moreover, a special thanks to the helpdesk’s people and Petra Isotalo for helping me with the connections and printing’s issues and to Maija for walking with me around the campus.

Continuing the work I had started in Padua, I immediately struggled to find the best model to propose for our paper on “Patient perceived outcomes”. It is so nice to be here and have the possibility to share and discuss with Katri and Tarja. More soon, work is in progress.

As soon as I arrived, my heart filled with joy as I realized I was to be living next to a lake. Whoa! I immediately planned to walk along the lake every day… and so I did (almost). The water is very relaxing and the colures change every day. People walk, bike and rest. Maija let me discover the forest area "Huuhanmäki". It was such a wonderful walk we took together with her beautiful children.

I am also enjoying the city and its festivals, along with its cafés.

It has being very interesting and well worth visiting the University hospital. What I noticed was that many problems are the same we encounter in Italy.

Along with the working exchange and sharing, I am also learning a little of the Finnish habits: the summer cottage where people spend the weekend, the sauna, the food, the concerts at the music house… and more to enjoy. Näkemiin!

The Forest Lake

I was alone on a sunny shore by the forest’s pale blue lake, in the sky floated a single cloud and on the water a single island. Ripe summer’s sweetness dripped in pearls from every tree and into my opened heart a little drop ran down.

As my secondment in Guildford has ended I'm wrapping up my experience over there for the 4 month secodment.

This was my first secondment in INEXCA project and I was excited to meet our colleagues and see the work they have done in University of Surrey. The campus in the University was beautiful and it had lot of services which I haven’t been used to in Finland for example Starbucks, Pizzeria, Asian restaurant. There is also a 5G Research Center which I had a chance to visit and do some IoT training thanks to Dr Payam Barnaghi.

My host Professor Sara Faithfull gave me an unforgettable Easter Sunday tour in the countryside around Pulborough and the South Coast of UK. She gave me a lot of detailed information about the old housing and buildings around the area which most likely I wouldn’t have never found out by myself. She also invited me to their home for Easter Sunday meal with her husband (and their dog) which was really lovely and delicious.

I lived about 20-minute walk away from the University and 30-minute walk to Guildford center. In general Guildford was a lovely town with good transportation to London (~30 minutes) and Gatwick airport. North Street (Guildford’s shopping street) and its alleys were lively almost any day of the week. It had from small shops and pubs to a large shopping center with big brands and design shops. Eating out in a restaurant or a pub were really cheap compared to Finnish prices.

During a weekend I had a one-day trip to a World Heritage city, Bath which is on the South-West of England. The city was built by Romans as it had hot springs. From the architecture of the city you could definitely see that it had a touch of Roman architecture and would recommend it to anyone who has a one day extra to spend.

With this I would like to thank all my colleagues in University of Surrey for the splendid 4 month stay in Guildford and I’m looking forward for meeting face-to-face in the near future in the INEXCA project.

Warmest greetings from the Lakeland! I was involved in INEXCA project thanks to my supervisor Professor Piera Poletti. That European collaboration gave me the opportunity to experience life and work in another country, to study and travel too. I started my secondment on 20th June. Homesickness cannot stop me because on the first week Tarja Kvist (University Researcher), Professor Katri Vehviläinen-Julkunen and Maija Hartikainen (Project Manager) created a family atmosphere I could still breath every day. I currently live at the university, in Canthia building: a fantastic accommodation by the lake. It was lucky for me to find a so calm, peaceful and green place. I especially appreciated Finnish silence, quietness and confidentiality culture.

About the Project: I collaborated with Ari Voutilainen on systematic literature reviews analysis about patient-realted quality of cancer care and it let me the chance to perfect my research methodology in that field.

About UEF: It was an honour for me to attend a doctoral dissertation defense about nurses’ readiness for evidence-base practice also because I met and talked with some international guests and collegues.

About Kuopio: I had my lunch on the top of Puijo tower, spent the Kuopio Mid-summer in the same area (an occasion to see a traditional Finnish “kokko”), visited the city center and the harbor.

About KUH: Professor Katri asked the collaboration of Minna Taam-Ukkonen (Director of Nursing) and other kind professionals to plan a visit to the Kuopio University Hospital. The new KUH is just breathtaking: modern, rich in light and flawless both logistically and stylistically.

About Friends: I had befriended all my Finnish supervisors, hospital’s professionals and families I met at the Catholic Church every Sunday. They invited me in to their home and in one occasion I cooked for them typical Italian foods such as “pasta al pesto” and “caprese”. On the other hand I’m actually addicted to a special Finnish chocolate called “Salmiakki” and local fresh berries.

Greetings from Padova! I started my INEXCA secondment about three weeks ago at CEREF, a research and education center headed by Professor Piera Poletti. During the first two weeks I have made many contacts and visited hospitals, thanks to Professor Poletti, given a presentation about the Finnish healthcare system and nursing education, gathered data for a systematic literature review concerning cancer care quality, had inspiring conversations about meta-analysis with Daniele Chiffi, a researcher from the university of Padova, participated to a FRAM course together with other INEXCA people, and, of course, tasted local specialties. Professor Poletti has tried to familiarize me with Italian habits and had some results too – I have learned to drink my coffee (espresso normale) without sugar (no zucchero), for instance. My apartment, the Bed and Breakfast Casa Yami is situated in the same cozy neighborhood as CEREF, just a 20-minute walk from the railway and bus stations. The landlord of Casa Yami, Giorgio, and his wife take a very good care of their customers so I have really enjoyed my stay there.

CEREF and San Dona Hospital.

Casa Yami accommodation.

University of Pittsburgh → University of Eastern Finland Professor Paula Sherwood, April 2016

I had a wonderful and enriching time in Kuopio. Being able to collaborate with scientists about issues that cut across countries was outstanding. I also had the opportunity to be exposed to multiple programs of research and to evaluate different methodologies and designs that were new and innovative. I look forward to going back!

Professor Katri Vehviläinen-Julkunen and Professor Paula Sherwood on the day of arrival.

University of Eastern Finland → University of Pittsburgh Professor Katri Vehviläinen-Julkunen, Autumn 2015

My secondment started one and a half week ago. It is great to be back in the University of Pittsburgh thanks for the financial support from INEXCA project by European Union. University of Pittsburgh is one of the oldest universities in USA as it was founded in year 1787 and it is ranking extremely well in all university rankings. Thus it is just a priviledge to be a visiting scholar here. It was wonderful to meet professor Paula Sherwood and our doctoral student Natalia Sak-Dankosky. Ever since arriving issues around INEXCA project have proceed with excellent efficiency. I have a private researcher room by the main entrance to the Faculty. The research in this unit is extremely strong in cancer patients' care and versatile NIH funded projects are going on. We can really learn a lot from this site. As a senior scientist I can participate to some courses for doctoral students to gain insights of the training and meet doctoral students and senior faculty. I will also give some talks in the seminars. Courses are given in the Cathedral of Learning, a 163 meters high building. Next year we will also get some senior researchers or doctoral students to UEF and our department.

Professor Paula Sherwood in her office.

The Cathedral of Learning.

I am staying in Bloomfield area near Shadyside in an old house hosted by Laila. I have a room with a bed and a table. We share the bathroom.

The weather is still quite nice and flowers are still blooming. However, fall is coming. Halloween is soon here and there are all kind of decorations outside the houses.

People seem to put many interesting things outside. I found a tree with a library for birds just nearby my apartment!

Best greetings from Pittsburgh! After two long weeks since I arrived to The City of Bridges and Steel, I can say that the decision to come here as a Visiting Scholar was absolutely the right one. Not only because according to the News & World Report 2016 Pitt School of Nursing ranks 5th among best Nursing Schools (1st in Nurse Anesthesia programs and 3rd in Clinical Nurse Leader programs) in the U.S., but also because it represents an extremely friendly and motivating working environment. Emphasizing the importance of independence as well as productive group work, it is definitely a great place for me to advance and gain new knowledge and skills needed to apply scientific research methods independently and critically. What is more, I am very happy to be able to experience more clinical aspects of nursing research as many of the projects are directly related to the clinical practice and are carried out in University of Pittsburgh Medical Center (UPMC) facilities. Besides the time I spend around the crazy and loud Oakland (Pitt's campus), I find the time to enjoy American culture by attending Penguins and Steelers games, or smashing apples during the Cider Mash Bash.